Page 21 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage
Introduction
Case fatality after aneurysmal subarachnoid hemorrhage (SAH) is reported from
30% to 50%.1 The main causes of death are the impact of the initial bleeding and
neurological complications, such as rebleeding and delayed cerebral ischemia (DCI).
Apart from the neurological complications, cardiac abnormalities occur frequently 2 after SAH. These abnormalities include ECG changes, elevated biochemical markers
of myocardial damage and heart failure, and decreased left ventricular function.
We hypothesized that cardiac abnormalities following SAH are related to the occurrence of death, poor outcome, and DCI. Therefore, we performed a meta- analysis on observational studies to assess the associations of cardiac complications with death, poor outcome, and DCI following aneurysmal SAH.
Materials and Methods
Search Strategy
Three investigators (I.B., D.H., and F.V.) independently performed a systematic search for studies regarding SAH accompanied by cardiac abnormalities, published between January 1960 and January 2007, using the electronic search engine PubMed. The following keywords were used: SAH* OR SAB* OR subarachnoid haemorrhage* OR subarachnoid hemorrhage* OR subarachnoid bleed* OR subarachnoid blood* OR intracranial aneurysm* OR intracranial bleed*. All these keywords were combined with the keywords: ECG*, electrocardiographic*, electrocardiography*, echocardiography*, echocardiographic, stunning*, myocardial damage*, myocardial necrosis*, left ventricular dysfunction*, LV dysfunction*, takotsubo*, apical ballooning*, CK*, CPK*, CK-MB*, MB*, troponin, BNP*, brain natriuretic peptide*, NT-pro-BNP* in different combinations.
Reference lists were manually cross-checked for additional publications. This procedure was followed until no additional studies were found. Because many publications were more than ten years old, no efforts were made to contact authors in case of missing data.
19